At Aquaticnet.com, we often get the following question:
Can my exercise physiologist/ athletic trainer/ personal trainer/ massage therapist work with clients and bill for services under my physical therapist's license?
It's such a hot topic, we'll discuss it in 3 parts.
The practice of physical therapy is different in each state in the union. The only way to understand what your state allows is to view your state's PT Practice Act.
Each state has different restrictions, but all states say the following: Physical therapy can only be performed by physical therapists, physical therapist assistants and physical therapy aides.
Each state differs on what it allows aides to do. Some states allow physical therapy aides to perform limited hands-on treatment under the direct supervision of a physical therapist or PTA. Other states do not allow aides to perform any treatment at all, limiting them to housekeeping and transport activities.
For example, Minnesota allows PTs to delegate some "tasks" to aides. Tasks are routine acts, performed under the line-of-site supervision of the PT. The aide is not allowed to make any alteration in the plan, or to progress the patient. The therapist must treat the patient at the beginning and end of treatment and the aide cannot provide the bulk of the treatment (otherwise, it would not be considered skilled care).
MN classifies anyone who is not a PT or a PTA as an aide. Even if that person is a highly trained clinical exercise physiologist, they become an AIDE when working under the supervision of a PT and when billing under the PT's provider code.
Therefore, if you are billing under the PT provider code, you must look to your state practice act to determine what your exercise physiologist is allowed to do. Whatever your state allows AIDES to do, your exercise physiologist can do -- no more.
If, in contrast, your exercise physiologist is operating under his/her own license, and is billing under his/her own provider code, then the exercise physiologist can do whatever your state permits its exercise physiologists to do.
In Minnesota, exercise physiologists are not recognized as licensed providers and do not have billing provider numbers. This does not mean your exercise physiologist cannot work with clients. It does mean that there your exercise physiologist cannot bill Medicare or most insurances for services; nor can he/she present these services as PT.
However, there are many personal trainers and exercise physiologists working 1:1 with clients in the water across the US. These fitness or exercise services are useful and typically legal, presuming the non-PT provider does not:
1. present himself as providing "physical therapy"
2. do not infringe on other profession's scope of practice as outlined by the state
3. do not fraudulently bill under PT
* One last note. Minnesota is the only state of which I am aware, where athletic trainers are permitted to work in outpatient PT clinics under the direct supervision of a PT and provide more than "aide" duties. The Minnesota ATC practice act is in conflict with the Minnesota PT practice act and allows ATCs to provide many "physical therapy" services when supervised by a PT.
This is a gray area for outpatient clinics and some choose not to allow athletic trainers to take advantage of this fact. I only mention it because, in Minnesota, you might be able to make an argument for using an athletic trainer and billing under PT. You cannot make the same argument for an exercise physiologist or massage therapist. Also, keep in mind that no matter what Minnesota allows, Medicare (and many other payers) will not allow anyone but a PT or PTA to bill for "physical therapy" services.